Just about anyone who doesn’t work directly for the U.S. Department of Health and Human Services, and has experience in health care, could not argue that Medicare’s reimbursement formularies adequately reimburse hospitals and doctors – AND keep a straight face. Medicare reimbursement, the bane of many hospitals’ existence, began, like many government programs, with a benevolent purpose and a seemingly meaningful methodology. And, like many government programs, has been so re-written, picked, prodded, subject to compromise, restricted by budgetary constraints, and sterilized by bureaucratic red tape and competing political interests…that the “well-meaningness” and logic are as endangered as the cancer patients I’m about to discuss. To give you an idea of what government is capable of, just look at the present U.S. Tax Code. Congress has created the necessity for an industry that costs this country upwards of $265 billion annually, just to comply with it.
The latest casualty in Medicare’s inconsistent, non-hippocratic formulary, may be 60,000 people per year with Non-Hodgkin Lymphoma. A NY Times article says that Medicare may arbitrarily cut its reimbursement for a new class of promising cancer drugs…the only treatment option for many disease sufferers. The drugs, Bexxar (GlaxoSmithKline) and Zevalin (Biogen Idec.) , part of a group called radioimmunotherapies, will be critical, life-saving drugs, if hospitals can afford to offer them as treatment options.
Marion Swan, a spokeswoman for the Lymphoma Research Foundation, says the drugs are the only option for some patients. “Our number one concern is that patients have access to all viable treatment options,” she said, “and it looks like this might be denying access.”
The worst part is that the Federal rules prevent hospitals from offering drugs to non-Medicare patients, if they cannot offer them to Medicare patients. This means anyone with regular insurance or the ability to pay for potentially the only drug that will save them, will be denied access.
This is where socialized medicine fails us…
Laissez-faire Healthcare Blog 